INTRODUCTION:  Lung cancer is a highly prevalent condition with non-small cell lung cancer (NSCLC) representing ~80%. Given its high prevalence and poor survival rates, it is important to understand costs associated with NSCLC treatment. OBJECTIVES: To carry out a study similar to the study by Ramsey (2008) in three European countries: France, Germany and UK. METHODS: Three similar administrative databases were accessed: Hospital Episode Statistics (England), Gesundheitsforen Leipzig (Germany), French Hospital Discharge system (France), using ICD-9/10 codes and treatment/surgery algorithms to identify NSCLC patients. An incidence population of NSCLC patients was obtained using an index year (ranging from 2007-2008), ensuring the absence of prior lung cancer (12-months). Data were extracted on treatment information, patient characteristics and disease staging. Average NSCLC treatments were estimated by age and severity. For England 20,081 patients were identified, for France, 15,061, for Germany, 1,038. RESULTS: In-patient length of stay was 8.9, 8.7 and 10.1 days for France, England, Germany respectively for the first year. Hospital in-patient costs in the first year amounted to €11,667, €11,363, €5,985 for France, Germany and England respectively. In year two these were €5,916 (France), €6,568 (Germany) and €1,156 (England). Hospital out-patient costs were in year 1 and 2: €2,313 - €676 (France); €1,925 - €1,766 (Germany); €1,209 - €834 (England). Medicine costs in year 1 and 2 amounted to: €3,542 - €321 (France); €4,488 - €3,805 (Germany); €8,593 yr1 only (England). Other costs reported for France and Germany in year 1 and 2, were €502 - €126 for France; €1,429 - €1,156 for Germany. Total costs reached €18,024 (yr1), €7,039 (yr2) France; €19,025 (yr1), €13,295 (yr2) Germany; €15,785 (yr1), €1,990 (yr2) England. Two-year costs totalled €25,063 (France); €32,500 (Germany); €17,777 (England). Subgroup analyses showed higher costs for elderly patients, those with non-metastatic disease and smokers. CONCLUSIONS: Considerable differences in average treatment costs were observed. In-patient costs dominate in the first year of treatment in all countries. The study highlights the costly nature of NSCLC